Inequalities in zoster disease burden: a population-based cohort study to identify social determinants using linked data from the U.K. Clinical Practice Research Datalink

Abstract

SummaryBackgroundZoster vaccination was introduced in England in 2013, where tackling health inequalities is a statutory requirement. However, specific population groups with higher zoster burden remain largely unidentified.ObjectivesTo evaluate health inequalities in zoster disease burden prior to zoster vaccine introduction in England.MethodsThis population‐based cohort study used anonymized U.K. primary care data linked to hospitalization and deprivation data. Individuals aged ≥ 65 years without prior zoster history (N = 862 470) were followed from 1 September 2003 to 31 August 2013. Poisson regression was used to obtain adjusted rate ratios (ARRs) for the association of sociodemographic factors (ethnicity, immigration status, individuals' area‐level deprivation, care home residence, living arrangements) with first zoster episode. Possible mediation by comorbidities and immunosuppressive medications was also assessed.ResultsThere were 37 014 first zoster episodes, with an incidence of 8·79 [95% confidence interval (CI) 8·70–8·88] per 1000 person‐years at risk. In multivariable analyses, factors associated with higher zoster rates included care home residence (10% higher vs. those not in care homes), being a woman (16% higher vs. men), nonimmigrants (~30% higher than immigrants) and white ethnicity (for example, twice the rate compared with those of black ethnicity). Zoster incidence decreased slightly with increasing deprivation (ARR most vs. least deprived 0·96 (95% CI 0·92–0·99) and among those living alone (ARR 0·96, 95% CI 0·94–0·98). Mediating variables made little difference to the ARR of social factors but were themselves associated with increased zoster burden (ARR varied from 1·11 to 3·84).ConclusionsThe burden of zoster was higher in specific sociodemographic groups. Further study is needed to ascertain whether these individuals are attending for zoster vaccination.

Zoster vaccination inequalities: A population based cohort study using linked data from the UK Clinical Practice Research Datalink

“…This study demonstrates that in a public funded healthcare system, vaccination inequalities exist during a crucial period of programme initiation, and identifies socio-demographic groups that could be targeted with tailored interventions to increase zoster vaccine uptake. Of particular interest is the finding of lower uptake among care home residents; we have shown recently that individuals in care homes are at higher risk of developing zoster,[ 49 ] and so are a group with possible double health inequity (of both zoster burden and zoster vaccine uptake). Lower vaccine uptake among these residents could be due to lack of awareness amongst care home staff about the newly introduced programme and issues around getting consent.…”

Associations of Lifestyle and Anthropometric Factors With the Risk of Herpes Zoster: A Nationwide Population-Based Cohort Study

“…We thus included age, sex, and various immunosuppressive treatments, and chronic conditions ( 2 , 26 ), including rheumatoid arthritis, systemic or subacute lupus erythematosus, inflammatory bowel disease, chronic kidney disease, asthma, chronic obstructive pulmonary disease, use of inhaled glucocorticoids, diabetes mellitus, hospital-diagnosed mood disorders, and severe immunosuppression (e.g., human immunodeficiency virus infection, hematopoietic stem cell transplantation, other cellular immune deficiency, leukemia, lymphoma, myeloma, use of oral glucocorticoids or other immunosuppressant drugs). We also identified the highest level of education achieved by each person (as a measure of socioeconomic status, which could affect lifestyle habits and health-seeking behavior ( 29 )) and country of origin as proxy for ethnicity (associated with zoster ( 29 ) and potentially linked to lifestyle through socioeconomic or other factors).…”

A systematic literature review of herpes zoster incidence worldwide

“…The characteristics of the 69 individual studies are provided in Table 1. The majority of studies were conducted in the United States of America (USA; n = 14), 6,15-27 followed by Canada (n = 6), [28][29][30][31][32][33] the United Kingdom (UK; n = 6), [34][35][36][37][38][39] Germany (n = 5), [40][41][42][43][44] Japan (n = 5), [45][46][47][48][49] the Netherlands (n = 5), 36,[50][51][52][53] Spain (n=5), [54][55][56][57][58] Taiwan (n = 4), [59][60][61][62] Australia (n = 3), [63][64][65] China (n = 3), [66][67][68] Italy (n = 3), [69][70][71] France (n = 2), 72,73 New Zealand(n = 2),…”

“…While 6 studies gave only one overall HZ incidence (Table 1), 58 studies stratified the incidence by age (Table 1), 33 studies by gender (Table 1), 23 studies by study year (Table 1), and 4 studies by ethnicity. 15,17,21,38 In 5 studies, the HZ incidence was reported for the overall general population as well as the immunocompetent population only. 6,21,24,41,71 Lastly, 3 studies reported the HZ incidence for two different case definitions of HZ.…”